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00:00We're about to hear from the great
00:02Doc Pandia out to the River Islands guest line we go time for cleared to play
00:07Take you inside the tent get you updated on the latest injuries in the bay proud to partner with UCSF health on this segment and bring
00:13In professor of orthopedic surgery, dr. Nirav Pandia. Hey doc. What's going on?
00:19I'm doing good. How are you guys doing? We're good
00:21But I imagine your social media feeds are quite busy with all of these injuries must be football season
00:28Debo Samuel, what do you want to tell our audience?
00:32So, you know, I think in general, you know, Debo had a relatively healthy season last year except for that scapular fracture
00:38But these soft tissue injuries are what we were always concerned about
00:41What we worry about a little bit more with him is that it's early on in the season
00:45These cap injuries can sometimes take three to four weeks to get better
00:48And as we're learning with Christian McCaffrey, sometimes a calf can become an Achilles issue
00:52So obviously concerned about him
00:55It seemed like he was able to get up and actually do another play after he sprained that calf
00:59But obviously something to be concerned about
01:02Particularly early in the season with a lot of games coming up on turf this year for that
01:05And when you look at the calf and we've talked about this before not all calf injuries are created equally
01:12Is it better off to have a higher calf strain or does that portend possibly to potential knee issues?
01:20I think a higher calf strain definitely is much safer
01:22Very rarely will you see a high calf issue and a knee kind of go hand in hand
01:27The reason why a higher calf issue is better is number one
01:30It's farther away from the Achilles and it's more in the muscle
01:33We know that pure muscle injuries as opposed to muscle injuries that occur where they transition in the tendon are much worse
01:38So higher up probably just a muscle issue
01:42Hopefully that's all it is and we get less worried about it
01:44Those are those two to three week injuries
01:46Versus one that goes a little bit lower down those you get a little bit more concerned about those are the ones that sometimes
01:51Draw up to four or five six weeks doc
01:53Let's talk Christian McCaffrey Kyle Shanahan sort of indicated like nobody knows if he's gonna be ready
02:00When the IR stint is up when it's up. It's a turf game Thursday night immediately the next week
02:06I mean, how are you looking at this a 49er fan should think what in terms of an expectation here? I
02:14Think the expectation without knowing the specifics, but just seeing how this has all played out
02:18If this is gonna be a six seven eight week long process, I think four weeks
02:22They're gonna maybe give him a go and see how he feels
02:24But just because he comes out of IR, you know four weeks from now
02:28It doesn't mean he's gonna go in and play in a full game. This may just be okay. Let's get into practice
02:32Let's see. How is the Achilles field?
02:34Honestly with most of these knowing that in the general population this takes about three months to get better
02:38I would not be surprised if we see a prolonged Christian McCaffrey return
02:43So if he comes off IR and it's like look, it's gonna be another couple weeks
02:46I don't think people should be concerned. I think that's the natural history of how long these take to get better
02:51Particularly at his position where he's explosive and part of this is just we just don't know how it's gonna feel when he plays
02:57He could look great. He goes out full contact practice and it's like, oh, I need another couple weeks
03:01So my fingers are crossed, but I'm not super hopeful. This is gonna be immediately Christian McCaffrey playing
03:07At week five after it is, you know off the IR
03:09What's the ramp up like once he's able to be cleared if it's after six weeks or seven weeks or eight weeks?
03:16Is he gonna need a certain amount of time to go through practice before he can even play at all?
03:22Yeah, ideally you wouldn't a lot of it has to do depend on you know, how conservative are they with him during IR?
03:27Are we gonna see him in a boot? Is he gonna potentially just be walking around?
03:30So let's just assume that they do nothing for the next couple of weeks. They're just shutting him down
03:34He's just doing stuff in the training room
03:36You might need a two to three week ramp up
03:38Simply because of what he's doing now if he was a lineman is a kicker
03:41You could probably get him back out there pretty quickly, but he's essentially straining that Achilles every single play
03:47He's out there. So that ramp up may be, you know, 25% intensity that first week and 50%
03:52So it could be a couple week ramp up before we see full participation Christian McCaffrey
03:56Even when he comes off the IR doc Pandia with us and I know this questions been out there
04:01But I I think it's good to keep reiterating it because it's probably on the minds of
04:06Our listeners and 49er fans. What is the risk whenever he's feeling healthy for?
04:12recurrence and rupture
04:15Yeah, so the risk of recurrence if you look at all athletes you get diagnosed with Achilles tendonitis
04:20Most studies show that risk is somewhere between four to ten percent
04:22So the vast majority of athletes who get Achilles tendonitis will not tear their Achilles
04:27But that risk is not minimal
04:28The risk of recurrence as long as you allow this to calm down and there aren't any chronic issues in that tendon meaning
04:35This isn't something that's going to leave
04:36The generation that tendon where it's going to be an issue that kind of goes on for a period of time
04:40The risk of recurrence is pretty low
04:42But why do you get worried for a running back who's over the age of 28?
04:45Who's had a lot of touches are there already some changes in that tendon?
04:49So as you can get more at risk to having pain and an impact on its performance. That's what I get worried about
04:54To a tongue of Iloa has been placed on IR with the Miami Dolphins after a third
05:00Concussion and this one looked to be almost as severe as the previous two when you get to that third concussion stage
05:07What is the not only the likelihood of another concussion to happen?
05:11But how much time it would take to recover once you have three of these?
05:16Yeah, I think you know with each concussion there is differing degrees of severity
05:20But each time we've seen him on the field, these have been pretty significant concussions
05:23We see him posturing on the field
05:25Everyone's extremely worried about him
05:27So each subsequent hit that that brain takes is more susceptible to get another concussion
05:31And then you're also kind of piling up all those secondary changes from having these repeated impacts
05:36So I think the duration of which he's going to take to come back from this is going to be much longer
05:41And secondarily then that risk of getting it again is really really high and you know
05:45Honestly that risk of concussion how it impacts you is different in that to each position
05:49obviously for a quarterback who has to process a lot of information at a high rate and has to kind of be dodging individuals that
05:55time to come back from a concussion could be
05:57Significantly longer than say someone who's not playing at a position where there's a lot of fast processing that has to take place
06:02So could this be four or five six weeks worth of recovery for him?
06:06Absolutely. It sounds like he's gonna meet with outside neurologists, but I think this is a point at which he needs to decide
06:11What are the risks?
06:12What does it mean for my career and I'm willing to take those and that's a very personal decision for him
06:16I don't think anyone else should be making that decision for him
06:18Doc also with everything going on with 49er pass catchers Ricky pierce
06:23Oh would be eligible week five it like is that is that crazy? Could he could he be ready to go by then? I?
06:30Think absolutely he could I mean the fact that you saw him a couple days afterwards, you know
06:34You know no sling moving his arm around it sounded like he's back in the training room a trainee
06:39And so I think from a physical standpoint
06:41It sounds like everything would be in line for this soft tissue injury to heal
06:44The key question is what's gonna happen when contact comes. Can you be aggressive?
06:47Can you handle any kind of discomfort there?
06:49But just purely from a muscle standpoint the way he's moving his arms and the videos we see I think it's absolutely possible
06:55And it's pretty remarkable that that's that's what we're talking about particularly with two offensive weapons
07:00Potentially not being out for a couple weeks. We may see Ricky Pierce
07:03I'll be in that person who contributes which is pretty crazy after a gunshot wound
07:06It's wild it's wild like I I was uncomfortable even asking you that question to be honest with you. Yeah
07:13Yeah, no, it's it's just once again speaks to how lucky he was and how his body has been able to heal
07:18Through this process just just simply remarkable doc. Thanks, man. We love it. Appreciate you
07:23No problem. Take care guys. Okay, there it is doc Pandya and the proceeding was sponsored by UCSF health